Practical skills for hard emotions, without substances
Many people do not relapse because they forgot they wanted to stay sober. They relapse because, in a difficult moment, alcohol or drugs seem like the fastest way to escape overwhelming emotions. Stress. Anger. Shame. Loneliness. Heartbreak. The challenge is not having emotions. It is knowing what to do with them. DBT builds exactly those skills.
At Present Moments Recovery, DBT runs through every level of care, from residential treatment in San Marcos through PHP and IOP in Carlsbad, and it is a particular emphasis of our IOP track. The two skill areas below are where most clients start. Explore them, or call and we will talk through how DBT fits into a plan.
Go deeper into the skills
Emotional Regulation Skills in Recovery
Learning to identify, understand, and manage emotions in healthier ways during recovery, instead of being run by them.
Learn more
Distress Tolerance Skills for Recovery
Practical techniques for getting through emotional crises without turning to alcohol, drugs, or other harmful coping.
Learn moreDialectical Behavior Therapy is an evidence-based psychotherapy originally developed by psychologist Dr. Marsha Linehan to help people who experienced intense emotions and struggled with impulsive or self-destructive behaviors. Today it is used far more broadly, supporting people with substance-use disorders, anxiety, depression, trauma-related conditions, and chronic stress. The core purpose has stayed the same: helping people respond thoughtfully instead of reacting impulsively. At Present Moments Recovery, DBT is a core part of our clinical approach because recovery is not just about stopping substance use. It is about developing healthier ways to respond when life gets hard.
What does dialectical mean?
The word dialectical refers to holding two seemingly opposite ideas at the same time. For example: I accept myself as I am, and I am committed to making meaningful changes. Recovery usually requires both. Clients practice self-compassion without becoming complacent, and pursue growth without believing they must become perfect. That balance between acceptance and change is DBT's defining principle.
Why DBT works so well in addiction recovery
Many people entering treatment have spent years trying to escape uncomfortable emotions. Alcohol, drugs, gambling, or other behaviors became the fastest way to numb emotional pain, and the temporary relief led to greater suffering over time. DBT teaches something different: difficult emotions are not dangerous, even when they are deeply uncomfortable. Instead of trying to eliminate feelings, clients learn to experience them safely, understand them, and respond in healthier ways. That shift reduces impulsive decisions and builds emotional resilience.
The four core DBT skill areas
- Mindfulness: noticing what is happening in the present moment without immediately reacting or judging yourself. That awareness creates the space where healthier decisions happen.
- Distress tolerance: practical ways to get through an emotional crisis without turning to alcohol, drugs, or other destructive behavior.
- Emotional regulation: understanding emotional responses, reducing emotional vulnerability, and responding on purpose during difficult situations.
- Interpersonal effectiveness: communication skills for setting boundaries, resolving conflict respectfully, and strengthening the relationships recovery depends on.
Learning to pause before reacting
One of the most valuable things DBT teaches is that there is a small space between an emotion and a behavior. During active addiction, that space can feel nonexistent: anger, shame, fear, or loneliness arrives, and the reach for a substance follows immediately. DBT expands the space. Within that pause, clients learn to ask: What am I feeling right now? What happened just before this? What do I need in this moment? What response will help me tomorrow, not just today? That simple pause often becomes one of the most powerful moments in recovery.
What a DBT session might look like
DBT sessions at PMR are collaborative, practical, and skill-based. Clients do not simply talk about problems. They learn techniques they can start using the same day: reviewing situations that felt overwhelming, identifying the emotions and triggers involved, practicing mindfulness and grounding exercises, role-playing difficult conversations, and setting realistic goals for the week ahead. Each session expands the recovery toolbox so clients are better prepared when life gets challenging.
DBT at each stage of treatment
- Residential treatment: skills are introduced in a structured setting with daily support, so clients build confidence before returning to everyday responsibilities.
- Partial Hospitalization (PHP): as clients spend more time outside treatment, DBT skills become the framework for managing real-world stress with intensive clinical backup.
- Intensive Outpatient (IOP): recovery starts happening in real life. Clients bring actual situations from work, family, and relationships back to group each week. DBT is a particular emphasis of our IOP track.
- Continuing care: the mindfulness, distress tolerance, emotional regulation, and communication skills keep serving clients long after formal treatment ends.
DBT for co-occurring conditions
Many people receiving addiction treatment also live with anxiety, depression, trauma and PTSD, mood disorders, or chronic stress. DBT is particularly helpful here because emotional dysregulation cuts across diagnoses. When integrated into a treatment plan that can include individual therapy, family involvement, coordinated psychiatric care, and medication management when appropriate, DBT helps clients build healthier responses regardless of which conditions are in play.
How families benefit
Families often carry years of fear, confusion, and emotional exhaustion. As clients develop healthier regulation and communication skills, family relationships usually begin to improve too. Family members can learn many of the same concepts: clearer communication, healthier boundaries, greater emotional awareness, and ways to support recovery without enabling. Healing becomes a shared process rather than an individual one.
“The beauty of our Continuum of Care model is a consistent treatment team from the beginning of the journey until the client is ready to fly solo. Clients are able to establish trust with their primary counselor, while the team supports them from the first day of care through their transition into the next appropriate stage of recovery.”
A message from Mark Gladden, Founder
One of the greatest gifts I see clients discover is that they don't have to be controlled by their emotions. I've watched people arrive believing that every feeling demanded an immediate reaction. Through DBT, they begin to realize that emotions are important, but they don't have to dictate every decision. When someone learns they can experience fear, sadness, anger, or disappointment without reaching for alcohol or drugs, they begin to build confidence in themselves again. Those moments are often where lasting recovery truly begins.
How DBT differs from CBT
Cognitive Behavioral Therapy focuses primarily on identifying and changing the unhelpful thought patterns that drive behavior. DBT focuses more directly on managing intense emotions, tolerating distress, improving relationships, and practicing mindfulness. They do not compete. At PMR they complement each other inside one individualized plan: CBT works on how you think, DBT works on how you respond emotionally, and together they build a stronger foundation for lasting recovery.
Frequently asked questions
What is Dialectical Behavior Therapy (DBT)?
Dialectical Behavior Therapy (DBT) is an evidence-based psychotherapy that helps people manage intense emotions, tolerate distress, improve relationships, and make healthier decisions. In addiction treatment, DBT teaches practical skills that help people respond to life's challenges without relying on alcohol, drugs, or other unhealthy coping behaviors.
How does DBT help people recovering from addiction?
Many people in recovery struggle with overwhelming emotions that can trigger cravings or relapse. DBT teaches clients to regulate emotions, tolerate distress, practice mindfulness, communicate more effectively, and reduce impulsive behavior, so they can respond thoughtfully instead of reacting automatically in difficult moments.
What is the difference between CBT and DBT?
Both are evidence-based, but they focus on different things. Cognitive Behavioral Therapy (CBT) helps people recognize and change unhealthy thought patterns that influence behavior. DBT focuses more heavily on emotional regulation, distress tolerance, mindfulness, and interpersonal effectiveness. At Present Moments Recovery, the two often work together within an individualized treatment plan.
Is DBT only used for borderline personality disorder?
No. Although DBT was originally developed for people with borderline personality disorder, it is now widely used for substance-use disorders, anxiety, depression, trauma and PTSD, emotional dysregulation, and chronic stress. It is recognized as one of the most effective therapies for building healthier emotional coping skills.
What skills are taught in DBT?
DBT is built around four skill areas: mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Together they help people understand their emotions, get through hard moments safely, communicate clearly, and strengthen relationships.
Does DBT help prevent relapse?
Yes. One of DBT's greatest values in addiction treatment is teaching people to navigate emotional crises without turning to alcohol or drugs. Rather than trying to eliminate uncomfortable feelings, clients learn practical techniques for managing them safely, which directly reduces relapse risk.
What happens during a DBT session?
Sessions are interactive and skill-focused. They may include reviewing emotionally challenging situations, practicing mindfulness exercises, learning coping strategies, role-playing difficult conversations, building distress tolerance techniques, and setting goals for continued growth outside the session.
Can DBT help with anxiety and depression?
Yes. DBT is frequently used to support people experiencing anxiety, depression, and trauma-related symptoms that occur alongside addiction. As part of an individualized treatment plan, it helps clients develop healthier ways of responding to emotional challenges across conditions.
Can family members benefit from DBT?
Absolutely. Many DBT concepts, including communication, emotional awareness, boundary-setting, and conflict resolution, are valuable for family members too. When families learn healthier ways to communicate and support one another, recovery often becomes stronger for everyone involved.
How long do DBT skills take to learn?
New emotional coping skills take time and practice. Many clients begin using DBT techniques during treatment and continue strengthening them through outpatient care and long-term recovery. The goal is steady growth over time, not perfection.
